Skin CAre - Rosacea

Introduction

Rosacea is an inflammatory skin disease that causes facial redness. You may mistake some of its characteristics — small, red, pus-filled bumps or pustules — for acne. In fact, rosacea has been called adult acne or acne rosacea, but the disease has little to do with the pimples and blackheads that commonly afflict teenagers. It's also a misconception that this red-faced condition is caused by drinking alcoholic beverages.

Rosacea affects mostly adults, usually people with fair skin, between the ages of 30 and 60. About 14 million Americans have this chronic skin condition. Although it's more common in women, men may develop more apparent signs of the disorder. It's not life-threatening, but it can affect your appearance and lower your self-esteem.

Left untreated, rosacea tends to be progressive, which means it gets worse over time. However, in most people rosacea is cyclic, which means it may flare up for a period of weeks to months and then signs and symptoms lessen for a while before rosacea flares up again. Besides acne, rosacea can also be mistaken for other skin problems, such as skin allergy or eczema. Once diagnosed, it's quite treatable.

Signs and symptoms

Signs and symptoms of rosacea include:

• Red areas on your face
• Small, red bumps or pustules on your nose, cheeks, forehead and chin (but not the same as whiteheads or blackheads)
• Red, bulbous nose (rhinophyma)
• Visible small blood vessels on your nose and cheeks
• Burning or gritty sensation in your eyes (ocular rosacea)
• Tendency to flush or blush easily

Rosacea usually appears in phases:

• Pre-rosacea. Rosacea may begin as a simple tendency to flush or blush easily, then progress to a persistent redness in the central portion of your face, particularly your nose. This redness results from the dilation of blood vessels close to your skin's surface. This phase may sometimes be referred to as pre-rosacea.
• Vascular rosacea. As signs and symptoms worsen, vascular rosacea may develop — small blood vessels on your nose and cheeks swell and become visible (telangiectasia). Your skin may become overly sensitive. Rosacea may also be accompanied by oily skin and dandruff.
• Inflammatory rosacea. Small, red bumps or pustules may appear and persist, spreading across your nose, cheeks, forehead and chin. This is sometimes known as inflammatory rosacea.

In severe and rare cases, the oil glands (sebaceous glands) in your nose and sometimes your cheeks become enlarged, resulting in a buildup of tissue on and around your nose (rhinophyma). This complication is much more common in men and develops very slowly over a period of years.

In addition, more than half the people with rosacea experience ocular rosacea — a burning and gritty sensation in the eyes. Rosacea may cause the inner skin of the eyelids to become inflamed or appear scaly, a condition known as conjunctivitis.

 

A severe case of rosacea can result in red, round, raised bumps (papules) and bulbous nose called rhinophyma (left). Changes typical of rosacea are redness of the cheeks, nose and central face, with small red bumps or pustules (right).

Causes

The cause of rosacea is unknown, but researchers believe it's likely due to some combination of hereditary and environmental factors.

Several theories exist as to what causes rosacea. One theory is that a blood vessel disorder causes vessels in the face to swell. Another is that the cause of rosacea is a chronic bacterial infection in the gastrointestinal system caused by a Helicobacter pylori infection. Some researchers have suggested that tiny mites (Demodex folliculorum) living in human hair follicles may play a role by clogging up sebaceous gland openings. Most people with rosacea have sun-damaged skin which may also play a contributing role. None of these theories has been conclusively proved, however.

One thing is certain — alcohol doesn't cause rosacea. While the consumption of alcohol can lead to flushing of the skin and may worsen rosacea, people who don't consume alcohol at all still can get rosacea.

Risk factors

Although the exact cause of rosacea remains a mystery, a number of factors can aggravate it or make it worse by increasing blood flow to the surface of your skin. Some of these include:

• Hot foods or beverages
• Spicy foods
• Alcohol
• Temperature extremes
• Sunlight
• Stress, anger or embarrassment
• Strenuous exercise
• Hot baths, saunas
• Corticosteroids
• Drugs that dilate blood vessels, including some blood pressure medications

When to seek medical advice

Unfortunately, rosacea rarely clears up on its own, and it tends to worsen over time if left untreated. If you experience persistent redness of your face, see your doctor or a skin specialist (dermatologist) for a diagnosis and proper treatment. Many over-the-counter skin care products contain ingredients such as acids, alcohol and other irritants, that may actually worsen rosacea. Because of the progressive nature of rosacea, an early diagnosis is important. Treatments tend to be more effective the earlier they're started.

Treatment

Although there's no way to eliminate rosacea altogether, effective treatment can relieve its signs and symptoms. Most often this requires a combination of prescription treatments and certain self-care measures on your part.

Your doctor also may recommend certain moisturizers, soaps, sunscreens and other products to improve the health of your skin. If hot flashes appear to trigger your rosacea, you might ask your doctor what treatment options are available for the signs and symptoms of menopause.

Medications
Doctors often prescribe topical antibiotics to treat rosacea, more for their anti-inflammatory properties than to kill bacteria. A common topical antibiotic prescribed is metronidazole (Metrocream, Metrogel, Noritate). Another prescription medication is azelaic acid (Azelex, Finacea), which reduces redness and inflammation.

Oral antibiotics also are prescribed because they tend to work faster than topical ones. In many cases, dermatologists first prescribe both oral and topical antibiotics to lessen signs and symptoms, followed by long-term use of a topical antibiotic alone to maintain remission. Some of the most common prescription oral antibiotics include tetracycline, minocycline, doxycycline and erythromycin.

• Isotretinoin (Accutane) is a powerful medication sometimes used for more severe cases of inflammatory rosacea. Doctors don't prescribe it for the treatment of mild cases or for telangiectasia or for redness of the face. Usually prescribed for cystic acne, it works to inhibit the production of oil by sebaceous glands. People who take it need close monitoring by a dermatologist because of the possibility of serious side effects. Isotretinoin is associated with severe birth defects, so it can't be taken by pregnant women or women who may become pregnant during the course of treatment or within several weeks of concluding treatment. In fact, the drug carries such serious potential side effects that women of reproductive age must participate in an Food and Drug Administration-approved monitoring program to receive a prescription for the drug. In addition, isotretinoin may increase the levels of triglycerides and cholesterol in the blood and may increase liver enzyme levels. For most people, however, these levels return to normal when the medication is stopped.

Your doctor may treat ocular rosacea with oral antibiotics.

The duration of your treatment depends on the type and severity of your symptoms, but typically you'll notice an improvement within one to two months. Because symptoms may recur if you stop taking medications, long-term regular treatment is often necessary.

Surgical
Enlarged blood vessels, some redness and changes due to rhinophyma often become permanent. In these cases, surgical methods, such as laser surgery and electrosurgery, may reduce the visibility of blood vessels, remove tissue buildup around your nose and generally improve your appearance.

Self-care

In addition to getting treatment from your doctor, you can play an active part in your treatment. One of the most important things you can do if you have rosacea is to minimize your exposure to anything that causes a flare-up. Because everyone is different, find out what factors affect you so that you can avoid them. Keeping a running list of your own flare-up triggers might help you identify the things that are a problem for you.

Here are other suggestions for preventing flare-ups:

• Wear sunscreen with a sun protection factor (SPF) of 15 or higher to protect your face from the sun.
• Protect your face in the winter with a scarf or ski mask.
• Avoid irritating your facial skin by rubbing or touching it too much.
• Avoid facial products that contain alcohol or other skin irritants.
• When using moisturizer with a topical medication, apply the moisturizer after the medication has dried.
• Use products that are labeled noncomedogenic. These won't clog your oil and sweat gland openings (pores) as much.
• Avoid overheating.
• If you wear makeup, consider using green- or yellow-tinted pre-foundation creams and powders, because they're designed to counter skin redness.
• Avoid alcohol.